Hypertension is usually associated with older people. However children do develop it too but is overlooked most often. As a result only one in four children with the condition have been diagnosed.
This was revealed in the August 22/29 issue of JAMA following a study concerning the long-term health of American children.
We are all aware that there is an epidemic of obesity among our children, but we do not yet realize that there is an epidemic of high blood pressure, going hand in hand with the obesity epidemic. Doctors blame this mainly on poor diets and lack of exercise. Such poor lifestyles build up serious health problems that could destabilize recent advances in the control of high blood pressure.
It is estimated that 2% to 5% or one in 20 American teenagers and children develop hypertension and high blood pressure, and it appears as though the percentage may soon be much higher. These diseases are not very easy to diagnose in children because there are many differences among children particularly when one considers sex, age and height but the long-term effects of hypertension and high blood pressure can include heart attack, heart failure, and stroke and kidney disease later on in life.
"There are approximately 2 million children in the country aged 3 to 18 who have high blood pressure, or hypertension," said Dr. David Kaelber of the Boston Children's Hospital who was lead study author.
The study was carried out by Dr. Matthew L. Hansen, at Case Western Reserve University, Cleveland, and his team in order to discover how frequently hypertension and pre-pension go unnoticed in children from three to eighteen years old. As part of the study, 14,187 children and teenagers who had gone to outpatient clinics for medical care at least thrice from June, 1999 to September, 2006 were observed.
The scientists discovered that 3.6% [507] of the children met the criteria for hypertension, but from them only 26% [131] of them had been diagnosed with high blood pressure and had records of it, whereas 74% [376] of the children had hypertension that had not as yet been diagnosed.
What was appalling was that of the 74% of the children, only 11% had the diagnosis noted in their electronic medical records.
The common symptoms of hypertension were a 1-year increase in age past age 3, high blood pressure readings beyond three and increase of 1 percent in height-for-age percentile, having an obesity-related diagnosis, and the number of blood pressure readings in the stage 2 hypertension range.
The hypertension was determined by the symptoms of a 1-year increase in age past age 3 and the number of high blood pressure readings beyond three.
The authors remarked, "Based on the data in this study, these conditions appear to be frequently undiagnosed by pediatric clinicians. Early, appropriate diagnosis is important because established evaluation guidelines and effective treatment for abnormal blood pressure exist."
Although myocardial infarction and heart failure have not appeared to be noticeable in children later on, hypertension in childhood is a precursor to hypertension in adulthood. Besides, childhood hypertension has been linked to early signs of cardiovascular disease, left ventricular hypertrophy being one of them.
The authors noted, "Identification of elevated blood pressure in children meeting prehypertension or hypertension criteria is important because of the increasing prevalence of pediatric weight problems and because secondary hypertension is more common in children than adults, requiring identification and appropriate work-up. If abnormal blood pressure is not identified by a patient's pediatric clinician, it may be years before the abnormal blood pressure is detected, leading to end-organ damage. Because effective treatments for abnormal blood pressure exist, these long-term sequelae can be avoided with early diagnosis.”
The authors offered two possible reasons to explain the low diagnostic rates for hypertension and prehypertension. The first was the lack of knowledge of normal blood pressure ranges and the other was the lack of awareness of a patient's previous blood pressure readings. They noted that blood pressure was documented in 94% of all the medical care visits.
They are of the opinion that a stepped up dependence on computerized records could help solve the problem, because they an easier and more reliable way of keeping track of pediatric patients from one visit to the next.
In the meantime, parents can help the rate of diagnosis by asking the doctor to check their child's blood pressure regularly, along with weight and height.
The authors listed a number of restrictions to the study. Some of these were no examination of physician traits possibly related to blood pressure evaluation and analysis, exclusive dependence on well-care visits, and lack of consistent procedures for measuring blood pressure and precision of blood pressure measurements.
However, the investigators emphasized, "Our study represents true under diagnosis of hypertension as these patients' hypertension was not recognized by clinicians throughout our health care system.”
It has been noted that The American Heart Association and the American Academy of Pediatrics now recommend screening children for hypertension from age 3, and for even younger children having risk factors such as low birth weight, congenital heart disease and longer than usual stays in the hospital, postpartum.
